Zion Ameh, founder of Mandate Health Empowerment Initiative and Convener of Mental Health Reforms Consortium, speaks to PLAC BEAM on mental health policy advocacy, the recent repeal of the Lunacy Act (now awaiting Presidential Assent) and the state of mental health in Nigeria
On the work of Mandate Health Empowerment Initiative:
We actually deal on two things. The first thing is on mental health, then drug abuse prevention and care. Two things are pertinent for us. The first is mental health reforms, the second is community mental health. For mental health reforms, we are very interested seeing that a nation like ours does not trivialise mental health reforms. For us, mental health reforms simply mean mental health legislations, mental health policies, mental health plans. When these three are in place for us, we feel we are fulfilling our mandate. This is what we have been doing for the past six years.
On mental health and those in psychiatric hospitals:
It is not limited to those in the psychiatric hospitals. I would like to appreciate the existence of the federal neuro-psychiatric hospitals that we have and some other mental health facilities that we have across Nigeria. When we talk about mental health, it does not only refer to those within the confines of the hospitals. There are a couple of mental health issues, disorders that can be attended to outside the neuro-psychiatric hospitals. So, mental health should not be seen as a concern that is only dealt within the confines of the psychiatric hospitals.
On the leading cause of mental health in Nigeria:
We have a dearth of statistics in Nigeria. There have been very few surveys or research on the subject matter of mental health in Nigeria. Thanks to WHO (World Health Organization) and also some other institutions here and there that are coming up with some form of research work. But then, over time, it’s been seen that the causative factors of mental illnesses or mental disorders in our country Nigeria has to do with issues like drugs, substance misuse and also poverty.
On the passage of the bill to repeal the Lunacy Act:
The passage of the Mental Health Bill is very good. We sincerely applaud all the actors that have been involved, the Federal Ministry of Health, WHO, Christian Blind Mission and other local mental-health NGOs. The passage of this bill, repealing the 1958 Lunacy Act, will help provide a legal framework to regulate mental health and substance abuse service delivery. This repeal will help protect the rights and the freedoms of those persons living with any mental health disorders or others who experience drug or substance misuse disorder. It will help ensure that Nigerians have access to a well-equipped, integrated mental-health service delivery. This is what we are calling for, this is what we have seen that is the gap in Nigeria especially as it concerns the mental health delivery across the nation.
On what was wrong with the old law:
The old law does not in any way match with realities of the mental health challenges that we have presently. Across the globe right now, there are trends of issues arising from either pandemic, socio-economic issues, insecurity, there are so many issues that are coming up now breeding all sorts of mental or psychological disorders. So, we are not condemning the 1958 Lunacy Act in totality, but we are saying that it does not match up to the realities of today’s mental health world. Whether in form of the treatment that should be available, care or psycho-social support that should be provided, whether in form of the rights or freedom of people who have come down with mental health disorders, substance misuse problems, all these have to be cared for. This repeal Act will help protect everyone who has come down with mental disorder or substance use disorder from discrimination, victimisation, dehumanisation, especially at the workplace, treatment centres, and works of life. This is something we have found obviously as a gap in the Lunacy Act of 1958.
On the advocacy of Mandate Health Empowerment Initiative for the bill:
Zion Ameh, Director of MHEI. Photo Credit: PLAC
There are so many things that happened that we can’t forget in a hurry because of how painful they were. So many institutions and persons misunderstood our stand for the repeal of this Lunacy Act. Some of our engagements were also challenged, not only misunderstood. But thankfully I can guarantee you today that we are on the same page. A lot of stakeholders were involved. The Association of Psychiatrists of Nigeria led by Professor Taiwo Sheikh, and the Clinical Psychologists Association were involved in this whole process.
But I want to say here that it is painful that some critical stakeholders did not see the need or the urgency to prioritise mental health in our dear country Nigeria. I know that suicide and depression might be under-reported, but I’m sure you’ve heard of either one, two or some cases of depression to anxiety to suicide. We have heard of professionals, of doctors, well-meaning Nigerians, who are dying by suicide. Every 40 seconds someone, somewhere out there is dying of suicide. One out of four Nigerians have been said to be likely to experience a mental health crisis in their lifetime. These are issues that call for concern and prioritisation of mental health.
We can’t overemphasise our engagement, but it is not just about the Mandate Health Empowerment Initiative, it is about Nigerians. It is about these great local NGOs that stuck out their necks in ensuring that the Lunacy Act of 1958 is repealed, ensuring that we got to where we are today on the subject matter of the Mental Health Bill in Nigeria.
Advice to NGOs involved in advocacy:
Please just stay focused. Try to really understand what you are advocating and stay on it. Build relationships around related stakeholders who are also on the same subject matter and see how you can work them in supporting your advocacy. Remember, it is not just about your organisation, it is not just about you, but about the country at large. Do not just drive your advocacy work singlehandedly, look out for other organisations, look out for other agencies, the ministries involved and carry them along. Get them involved in what you are doing, get them to give commitment in what you are doing, get them to give their resources if they have, see how you can stay on it and drive it.
On whether mental health problems can be avoided?
There are some of them that we could avoid; we could come up with coping mechanisms. But again, some categories of mental illnesses are biological, we can’t avoid them. We can only counsel, guide, try to curb these kinds of disorders from happening. But for the likes of ones caused by poverty, insecurity like we have currently in this country.
The issue of insecurity has bred a lot of anxiety disorders, has thrown people into depression, has taken people into a psychological state that they can no longer fit into their normal or regular functioning at workplace. So, this kind can be avoided. The likes that are being caused by drug substance misuse can be avoided. That’s why there must be conscious efforts to not only sensitise people about drug misuse issues, but people need to also understand the preventive measures.
On what Nigerians can do to protect their mental health:
For me, the first thing will be knowledge, accepting new knowledge about mental health. There is so much misconception out there, so many myths around mental health. People believe that mental health should not be discussed. People believe that when you come down with mental health or your family member comes down with mental health, you should be an outcast, you should not associate. This is not correct. You need to understand first of all what exactly is mental health because it is not just people who are eating from the waste bin, it is not about people who come down with psychosis or maybe schizophrenia and they are putting on rags.
Mental well-being is about you listening to me right now, realising your ability and potential. It is about you developing coping mechanism to deal with normal, daily stress. It is about you being productive, finding reasons to contribute to your community, to your society. Nigerians should look to understanding what exactly mental health is, to really know what mental well-being is really about. Until you have the knowledge of these, the wrong information about mental health will just be what will be trending.
So, beyond just knowing about mental health, please begin to consciously care for your mental health. There is nothing wrong with going for mental health assessment. In the next few weeks, in celebrating our sixth anniversary, we are having capacity building and community mental health outreach programme across 11 States. So, all of these is to build the capacity of health personnel so that at least, they can be able to provide access to Nigerians to carry out assessment or screening on their mental health and then provide the right referral systems for them. Most of the general hospitals have psychiatric units, you can find some of them at some of the tertiary institutions. Some of the things we are seeing across Nigeria in terms of suicide, people coming down with depressive conditions, it didn’t just jump on them. It begins from mild to moderate. When it is not managed or treated, it goes to severe.
Cover Photo Credit: MHEI
